ABOUT
To know if you are eligible for PACE CNY you need to have an assessment. There are two ways in which participants can choose to have their assessment:
Direct Eligibility
If you meet the Direct Eligibility (DE) criteria, you can have PACE CNY complete your assessment, which will see if you are eligible to join our plan. If you select DE our plan will conduct your assessment. We will let you know if you are eligible for PACE. If you are found eligible, we can work with you to help you join our plan. All DE assessments will be reviewed by the New York Independent Assessor Program (NYIAP) to see if you can remain in the plan. You should note that our DE assessment only applies towards enrollment into PACE CNY.
New York Independent Assessor Program
You can contact NYIAP to schedule an assessment. NYIAP is the state-contracted independent assessor, that oversees and conducts assessments for individuals seeking personal care services, consumer directed personal assistance services, or Managed Long-Term Care (MLTC), including PACE. If you choose to have a NYIAP assessment and you are found eligible for PACE enrollment, there will be no further review. If you are not eligible for PACE enrollment, the NYIAP assessment can also be used to see if you are eligible for other MLTC programs.
You will receive the PACE DE Disclosure Letter which you should review carefully prior to deciding between either PACE DE or New York Independent Assessor.
Payment Information
About PACE Payment
Fees are completely covered for individuals eligible for both Medicare and Medicaid, or Medicaid only benefits. (Some Medicaid recipients may have to spend down)
Those who are ineligible for Medicaid and Medicare or eligible for Medicare only are responsible for a monthly fee that may be paid through private payment or private insurance (with prior approval).
PACE CNY participants may be personally liable for costs of unauthorized or out-of-PACE CNY program agreement services, other than emergency services.
Note: PACE CNY staff will provide information on Medicaid eligibility requirements.
Medicaid Information
Please contract Michele Murphy in Loretto Finance at:
Phone: 315-413-3370
Email: [email protected]
Fax: 315-413-3031
- Download Access NY Health Care Insurance Application DOH-4220
- Download Supplemental A Application DOH-5178A (Supplement to Access NY Health Care Application DOH-4220)
- Download What Documents You Need to Provide
- Download Confidential Financial Disclosure Information
Medicare Part D
As a caregiver, the responsibility that comes with medication management can be daunting. With PACE CNY, you can rest assured that your loved one will receive the medication they need, when they need it.
PACE CNY provides all medications, including over-the-counter drugs, that have been prescribed by the PACE CNY primary care or specialty physician providers. PACE CNY is considered a Medicare Part D plan, therefore, once you join PACE CNY you must dis-enroll from your existing Part D plan. PACE CNY must coordinate, order, and pay for all your prescriptions as prescribed. Medications are pre-poured weekly, or filled monthly depending on our participant’s needs.
Enrollment Agreement
Upon enrollment, our interdisciplinary team completes an in-depth healthcare evaluation and develops a comprehensive, individualized care plan based on medical, physical, emotional and social needs. The individual’s enrollment becomes effective of the first of the month.
Enrollment Agreement
What’s the Enrollment Process?
Discover how to enroll in a PACE CNY program by visiting our detailed enrollment guide today.
Learn about Enrollment